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dc.contributor.authorRustad Indregard, Anne Marthe
dc.contributor.authorNussle, Hans Martin
dc.contributor.authorSmåstuen, Milada Cvancarova
dc.contributor.authorVandvik, Per Olav
dc.contributor.authorTesli, Martin Steen
dc.contributor.authorGather, Jakov
dc.contributor.authorKunøe, Nikolaj
dc.date.accessioned2024-04-29T08:36:58Z
dc.date.available2024-04-29T08:36:58Z
dc.date.issued2024-03-06
dc.description.abstractBackground - Open-door policy is a recommended framework to reduce coercion in psychiatric wards. However, existing observational data might not fully capture potential increases in harm and use of coercion associated with open-door policies. In this first randomised controlled trial, we compared coercive practices in open-door policy and treatment-as-usual wards in an urban hospital setting. We hypothesised that the open-door policy would be non-inferior to treatment-as-usual on the proportion of patients exposed to coercive measures.<p> <p>Methods - We conducted a pragmatic, randomised controlled, non-inferiority trial comparing two open-door policy wards and three treatment-as-usual acute psychiatric wards at Lovisenberg Diaconal Hospital in Oslo, Norway. An exemption from the consent requirements enabled inclusion and random allocation of all patients admitted to these wards using an open list (2:3 ratio) administrated by a team of ward nurses. The primary outcome was the proportion of patient stays with one or more coercive measures, including involuntary medication, isolation or seclusion, and physical and mechanical restraints. The non-inferiority margin was set to 15%. Primary and safety analyses were assessed using the intention-to-treat population. The trial is registered with ISRCTN registry and is complete, ISRCTN16876467.<p> <p>Findings - Between Feb 10, 2021, and Feb 1, 2022, we randomly assigned 556 patients to either open-door policy wards (n=245; mean age 41·6 [SD 14·5] years; 119 [49%] male; 126 [51%] female; and 180 [73%] admitted to the ward involuntarily) or treatment-as-usual wards (n=311; mean age 41·6 [4·3] years; 172 [55%] male and 138 [45%] female; 233 [75%] admitted involuntarily). Data on race and ethnicity were not collected. The open-door policy was non-inferior to treatment-as-usual on all outcomes: the proportion of patient stays with exposure to coercion was 65 (26·5%) in open-door policy wards and 104 (33·4%) in treatment-as-usual wards (risk difference 6·9%; 95% CI –0·7 to 14·5), with a similar trend for specific measures of coercion. Reported incidents of violence against staff were 0·15 per patient stay in open-door policy wards and 0·18 in treatment-as-usual wards. There were no suicides during the randomised controlled trial period.<p> <p>Interpretation - The open-door policy could be safely implemented without increased use of coercive measures. Our findings underscore the need for more reliable and relevant randomised trials to investigate how a complex intervention, such as open-door policy, can be efficiently implemented across health-care systems and contexts.en_US
dc.identifier.citationRustad Indregard, Nussle, Småstuen, Vandvik, Tesli, Gather, Kunøe. Open-door policy versus treatment-as-usual in urban psychiatric inpatient wards: a pragmatic, randomised controlled, non-inferiority trial in Norway. The Lancet Psychiatry. 2024
dc.identifier.cristinIDFRIDAID 2253996
dc.identifier.doi10.1016/S2215-0366(24)00039-7
dc.identifier.issn2215-0374
dc.identifier.issn2215-0366
dc.identifier.urihttps://hdl.handle.net/10037/33437
dc.language.isoengen_US
dc.publisherElsevieren_US
dc.relation.journalThe Lancet Psychiatry
dc.relation.projectIDNorges forskningsråd: 309903
dc.relation.projectIDHelse Sør-Øst RHF: 2020113
dc.rights.holderCopyright 2024 The Author(s)en_US
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0en_US
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)en_US
dc.titleOpen-door policy versus treatment-as-usual in urban psychiatric inpatient wards: a pragmatic, randomised controlled, non-inferiority trial in Norwayen_US
dc.type.versionacceptedVersionen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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